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Pediatric Gastroenterology, Hepatology... Jan 2019Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we...
Crohn disease has a wide spectrum of clinical presentations and rarely can present with complications such as a bowel stricture or fistula. In this case report, we describe a 17-year-old male who presented with a history of recurrent anterior abdominal wall abscesses and dysuria. He was diagnosed with Crohn disease and also found to have a fistulous communication between the terminal ileum and a patent urachus. An ileocecectomy with primary anastomosis and complete resection of the abscess cavity was performed. He is on azathioprine for maintenance therapy and currently in remission. Clinicians should have a high index of suspicion for this complication in Crohn disease patients presenting with symptoms suggestive of urachal anomalies such as suprapubic abdominal pain, dysuria, umbilical discharge, and periumbilical mass.
PubMed: 30671379
DOI: 10.5223/pghn.2019.22.1.90 -
International Journal of Surgery Case... 2018A fistula involving a patent urachus in a patient with Crohn's disease is rare. Here we report ileourachal fistula formation in two patients with Crohn' disease.
INTRODUCTION
A fistula involving a patent urachus in a patient with Crohn's disease is rare. Here we report ileourachal fistula formation in two patients with Crohn' disease.
CASE PRESENTATIONS
The first patient was a 29-year-old man with Crohn's disease and ileitis, and the second patient was a 43-year-old man with Crohn's disease and ileitis. One of the patients showed pus/fecal discharge via the umbilicus. Both patients were eventually diagnosed with an ileourachal fistula associated with Crohn's disease. In the first patient, the urachal remnant was connected to the urinary bladder and a Crohn's disease-related intestinal lesion had formed a fistula to the urachus. In the second patient, a periumbilical inflammatory lesion extended to the bladder through the urachal remnant and to a longitudinal ulcer of the ileal lesion. The first patients underwent partial ileal resection, and partial cystectomy, while the second patient underwent urachal curettage, partial ileal resection, and partial cystectomy. In both.
CONCLUSION
In cases of Crohn's disease with an enterocutaneous fistula or pus discharge via the umbilicus, an examination to detect an urachal remnant with a fistula from the diseased intestine should be performed.
PubMed: 30390487
DOI: 10.1016/j.ijscr.2018.10.031 -
Ultrasound International Open Sep 2018
PubMed: 30255165
DOI: 10.1055/a-0633-3879 -
Equine Veterinary Journal May 2019Umbilical remnant infection and patent urachus are an important cause of morbidity for the equine neonate. Left untreated, fatal complications can develop. Identifying...
BACKGROUND
Umbilical remnant infection and patent urachus are an important cause of morbidity for the equine neonate. Left untreated, fatal complications can develop. Identifying risk factors for post-operative complications after surgery are important for estimating prognosis.
OBJECTIVES
To identify risk factors associated with post-operative complications in foals undergoing umbilical remnant resection due to patent and/or infected umbilical remnants.
STUDY DESIGN
Retrospective case series.
METHODS
Foals undergoing umbilical remnant resection due to patent urachus or infected remnants at the Marion duPont Scott Equine Medical Center from 2004 to 2016 were included in the study. Data were obtained from medical records and associations between outcomes and post-operative complications, and pre or intraoperative clinical variables were assessed using bivariable and multivariable analyses.
RESULTS
Eighty-two foals underwent umbilical remnant resection of which 73 (89.0%) survived to discharge. The urachus was the most commonly affected structure being patent and/or infected in 84.1% of cases. Concurrent diseases were present in 60.6% of foals prior to surgery, with diarrhoea and septic arthritis being most common. The presence of preoperative septic arthritis and/or physitis were significantly associated with nonsurvival (OR 33; 95% confidence interval 1.1-985.2; P = 0.04). Longer anaesthesia time (OR 1.4; 95% confidence interval 1.1-1.7; P = 0.02) and failure of passive transfer of immunoglobulins (OR 5.9; 95% confidence interval 1.2-29.04; P = 0.03) were associated with increased odds for post-operative complications.
MAIN LIMITATIONS
It is not known if medical treatment alone would have been successful in foals that did not receive preoperative medical treatment.
CONCLUSIONS
Overall survival is high after surgical excision of umbilical remnants. The presence of preoperative septic arthritis and/or physitis was associated with decreased survival and failure of passive transfer of immunoglobulins and longer anaesthesia times were associated with increased odds for post-operative complications.
Topics: Animals; Female; Horse Diseases; Horses; Male; Postoperative Complications; Retrospective Studies; Risk Factors; Treatment Outcome; Umbilicus; Urachus
PubMed: 30216491
DOI: 10.1111/evj.13021 -
The Journal of Emergency Medicine Sep 2018Rare causes of abdominal pain include abnormalities of the urachus, including patent urachus and urachal cyst with or without infection. However, reviews discussing...
BACKGROUND
Rare causes of abdominal pain include abnormalities of the urachus, including patent urachus and urachal cyst with or without infection. However, reviews discussing etiology of abdominal pain, even in children, may completely omit mention of urachal remnants.
OBJECTIVES
Determine the incidence of symptomatic urachal remnants in patients presenting to the emergency department (ED), including common presenting findings and method of diagnosis.
METHODS
A retrospective chart review was performed of all patients presenting to the ED with abdominal pain who were diagnosed with urachal remnants, including patent urachus or urachal cyst or abscess over a period of 11 years and 7 months in one hospital.
RESULTS
There were a total of 833,317 ED visits over the time period of the chart review, with 76,954 patients or 9.2% presenting with a complaint of abdominal pain. Twenty-four patients were identified, or 0.03% of those presenting with abdominal pain. Ages ranged from 16 days to 59 years. Among those 18 years or older, there was a male-to-female ratio of 1:1 of 14 patients. Thirteen patients (54.2%) initially presented with drainage from the umbilicus.
CONCLUSIONS
Although rare, symptomatic disorders of urachal remnants may present at any age. These disorders should be kept in mind by the emergency physician among the broad list of differential diagnoses accounting for abdominal pain. Urachal cyst and abscess may present with or without drainage from the umbilicus. Drainage from the umbilicus is highly suggestive, but not pathognomonic, of a urachal anomaly, and patients should be imaged to make a definite diagnosis and assist in the management plan.
Topics: Abdominal Pain; Adolescent; Adult; Child; Child, Preschool; Diagnosis, Differential; Emergency Service, Hospital; Female; Humans; Incidence; Infant; Infant, Newborn; Male; Middle Aged; Retrospective Studies; Urachal Cyst; Urachus
PubMed: 30072186
DOI: 10.1016/j.jemermed.2018.05.023 -
Urology Journal Feb 2019Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing...
PURPOSE
Infra-vesical obstruction is uncommon in infants and generally due to urethral valves. Congenital urethral strictures (CUS), instead, defined as a concentric narrowing of the urethral lumen, are exceedingly rare in infants.
MATERIALS AND METHODS
We reviewed our experience with 7 patients treated at our institution for CUS
RESULT
In a single patient, the urethral stricture was an isolated condition, 3 had a Prune Belly Syndrome (PBS) and the remaining 3 had an Ano-Rectal Malformation (ARM). Four patients had upper tract dilatation detected on prenatal ultrasound. Five patients had upper tract dilatation on postnatal ultrasound. Five patients had impaired renal function at diagnosis and 3 required renal transplantation eventually. On micturating cystourethrography, all strictures were located in the anterior urethra and 4 cases had associated vesicoureteral reflux. In all cases, but one urinating via a patent urachus, initial management included insertion of a supra-pubic catheter. Subsequently, the CUS could be treated by dilatation or endoscopic incision in the 3 patients with Prune belly syndrome, whereas 3 of the remaining 4 required a formal urethroplasty.
CONCLUSION
Diagnosis and treatment of CUS in infants and children remain difficult to standardize. At presentation, urinary diversion is key to avoid progressive renal damage in infants that can already have an impaired renal function. Anterior strictures in patients with PBS are likely to be fixed with progressive dilatation. In other patients, instead, urethroplasty should be considered. A formal vesicostomy or, if possible, an urethrostomy can allow temporizing final surgery. A major problem we experienced in the treatment of CUS is that the small endoscopicinstruments required in this age group make urethral instrumentation more difficult and less effective than in olderchildren and adults.
Topics: Abnormalities, Multiple; Anal Canal; Dilatation; Humans; Infant; Prune Belly Syndrome; Plastic Surgery Procedures; Rectum; Retrospective Studies; Urethral Stricture; Urinary Diversion; Vesico-Ureteral Reflux
PubMed: 30058064
DOI: 10.22037/uj.v0i0.4045 -
Gan To Kagaku Ryoho. Cancer &... Apr 2018A woman in her 50s was admitted to our hospital with fever and lower abdominal swelling. Abdominal CT/MRI examinations revealed irregular thickening of the transverse...
A woman in her 50s was admitted to our hospital with fever and lower abdominal swelling. Abdominal CT/MRI examinations revealed irregular thickening of the transverse colon wall, which was attached to a subcutaneous abscess. An abdominal wall mass, a patent urachus, and a tumor in the 5th segment of the liver were also noted. Colonoscopy revealed type 2 advanced transverse colon cancer. The solitary, sessile tumor was observed at the apex of the bladder under cystoscopy, suggesting the formation of the urachal carcinoma. Transcutaneous liver biopsy obtained from the liver tumor indicated adenocarcinoma, which was morphologically different from the existing transverse colon cancer. Right hemicolectomy with resection of the umbilicus, abdominal wall, urachus, and part of the bladder wall was performed. Diagnosis of the transverse colon cancer invading the abdominal wall and bladder was confirmed by histopathological examination. Hepatectomy was performed in the next surgery, and the tumor was histopathologically diagnosed as an intrahepatic cholangiocarcinoma. Both the transverse colon cancer and the intrahepatic cholangiocarcinoma were radically resected. Radical surgical diagnostic resection may be valuable in cases of multicentric cancers of unknown primary origin, if radical resection of each individual tumor is required.
Topics: Abdominal Wall; Bile Duct Neoplasms; Cholangiocarcinoma; Colonic Neoplasms; Female; Humans; Liver Neoplasms; Middle Aged; Neoplasm Invasiveness; Neoplasms, Multiple Primary
PubMed: 29650846
DOI: No ID Found -
Journal of Medical Ultrasonics (2001) Jul 2018A 26-year-old pregnant woman was diagnosed with fetal bladder prolapse following rupture of a patent urachus/urachal cyst, based on the finding of cyst disappearance... (Review)
Review
A 26-year-old pregnant woman was diagnosed with fetal bladder prolapse following rupture of a patent urachus/urachal cyst, based on the finding of cyst disappearance with replacement with an infra-umbilical, extra-abdominal solid soft-tissue mass, mimicking bladder exstrophy. The neonatal findings confirmed the prenatal diagnosis. The baby was healthy and had a successful surgical correction. This report provides clues to differentiating ruptured bladder prolapse from bladder exstrophy as follows: (1) well-documented urachal cyst with urine-filled mass in the early gestation, (2) development of solid soft-tissue mass shortly after disappearance of the urachal cyst, and (3) no other structural abnormalities (bladder exstrophy is usually associated with abnormal genitalia, epispadias, or pubic diastasis). This study underlines the differentiation between the two entities because of the vast difference in prognosis, management, and proper counseling.
Topics: Adult; Diagnosis, Differential; Female; Fetal Diseases; Humans; Infant, Newborn; Male; Pelvic Organ Prolapse; Pregnancy; Rupture, Spontaneous; Ultrasonography, Prenatal; Urachal Cyst; Urinary Bladder Diseases
PubMed: 29318419
DOI: 10.1007/s10396-017-0856-8 -
Journal of Paediatrics and Child Health Nov 2017The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and...
The umbilicus is involved in a wide range of abnormalities in infants and children. The most severe are evident at birth and include exomphalos (omphalocele) and gastroschisis, both of which can be life-threatening but are easy to diagnose. Exomphalos is often associated with other congenital abnormalities, whereas the associated problems in gastroschisis are largely confined to the gut. Infection of the umbilicus in the neonate presents as omphalitis. The causes of a moist umbilicus following separation of the umbilical stump are multiple, from the relatively minor umbilical granuloma or ectopic bowel mucosa to the more significant patent urachus that leaks urine. Patency of the entire vitello-intestinal (omphalomesenteric) tract allows air and faecal fluid to drain through the umbilicus. The clinical manifestations of persistence of the vitello-intestinal tract vary markedly according to which part remains: clinical presentations include melaena and anaemia, closed-loop bowel obstruction and Meckel diverticulitis. An umbilical hernia occurs when the umbilical cicatrix fails to close. On the other hand, the umbilicus has its uses, which range from being a route for intravenous access in the neonate to being a convenient point of access in laparoscopic surgery.
Topics: Gastroschisis; Hernia, Umbilical; Humans; Infant, Newborn; Meckel Diverticulum; Ultrasonography, Prenatal; Umbilicus
PubMed: 29148196
DOI: 10.1111/jpc.13760 -
Medicine Jul 2017Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the...
RATIONAL
Patent urachus (PU) is due to an incomplete obliteration of the urachus, whereas patent omphalomesenteric duct (POMD) is due to an incomplete obliteration of the vitelline duct. These anomalies are very rarely associated with one another. We describe a case of a newborn with a PU associated with a POMD, who was diagnosed by an abdominal ultrasound (US) and laparoscopy, and managed with a minimally invasive excision.
PATIENT CONCERN
A 28-day-old male neonate was referred to our hospital to investigate a delay in umbilical healing, with blood-mucinous material spillage for 3 weeks prior to the referral. The baby had no symptoms and was in good general health.
DIAGNOSIS
After a thorough cleaning of the umbilical stump, a clear granuloma with a suspected fistula was evident under the seat of the ligature of the stump. An abdominal US examination revealed the formation of a full communication, starting below the umbilical stump and developing along the anterior abdominal wall that connected with the bladder dome. The US also revealed a tubular formation containing air, which was compatible with POMD, in the deepest portion of the same umbilical stump. Considering these findings, the rare diagnosis of a PU associated with a POMD duct was suspected.
INTERVENTIONS
The child was then hospitalized for an elective laparoscopy that confirmed the US picture, and a minimally invasive excision was performed.
OUTCOME
The postoperative course was favorable and uneventful.
LESSONS
Our case underlines the importance of evaluating all persisting umbilical lesions without delay when conventional pharmacological therapies fail. Using a US as the first approach is valuable and should be supported by laparoscopy to confirm the diagnosis; a minimally invasive excision of the remnants appears to be an effective therapeutic approach.
Topics: Humans; Infant, Newborn; Laparoscopy; Male; Minimally Invasive Surgical Procedures; Ultrasonography; Umbilicus; Urachus
PubMed: 28746173
DOI: 10.1097/MD.0000000000007087